Comorbid Depression Is Associated With Increased Healthcare ... : Psychosomatic Medicine (original) (raw)

Original Articles

Comorbid Depression Is Associated With Increased Healthcare Utilization and Lost Productivity in Persons With Diabetes: A Large Nationally Representative Hungarian Population Survey

Vamos, Eszter Panna MD; Mucsi, Istvan MD, PhD; Keszei, Andras MD, PhD; Kopp, Maria S. MD, PhD, DSc; Novak, Marta MD, PhD

From the Institute of Behavioral Sciences (E.P.V., I.M., A.K., M.S.K., M.N.), Semmelweis University, Budapest, Hungary; 1st Dept. of Internal Medicine (E.P.V., I.M., M.N.), Semmelweis University, Budapest, Hungary; Semmelweis University Research Group for Pediatrics and Nephrology, Budapest, Hungary; and the Department of Psychiatry (M.N.), University Health Network, University of Toronto, Toronto, Ontario, Canada.

Address correspondence and reprint requests to Marta Novak, Institute of Behavioral Sciences, Semmelweis University, Budapest, Nagyvarad ter 4., Budapest, Hungary, H-1089. E-mail: [email protected]

Received for publication May 23, 2008; revision received January 8, 2009.

This study was supported by project 1/002/2001 from the National Research and Development Programmes (NKFP), project HUN/00/002/A/01/99 from the United Nation Development Program (UNDP), and projects T-32974 (2000) and TS-040889 from the National Research Fund (OTKA). This paper was supported by the János Bolyai Research Scholarship of the Hungarian Academy of Sciences (M.N.).

Abstract

Objective:

To estimate the prevalence of depression among people with diabetes and to examine the association of comorbid depression with lost productivity and health resource utilization in persons with and without diabetes.

Methods:

Cross-sectional survey, enrolling 12,643 individuals aged >18 years. Clustered, stratified sampling procedure was utilized. This sample represented 0.16% of the Hungarian adult population according to age, gender, and geographic regions. The severity of depressive symptoms was measured by the abbreviated Beck Depression Inventory.

Results:

The prevalence of diabetes in the sample was 6.2% (95% Confidence Interval (CI) = 5.7–6.6), and 13.4% (95% CI = 12.8–13.9) were classified as depressed. Adults with diabetes were two times more likely to have depression (adjusted odds ratio (OR) = 1.83, 95% CI = 1.53–2.19, p < .001) versus individuals without diabetes. Compared with nondepressed people with diabetes, those with diabetes and comorbid depression were older, less educated, more likely to be female and physically inactive, less likely to be employed, and married and had more comorbidities. In multivariate regression analyses, people with diabetes and depression had significantly greater odds of prolonged bed days due to illness (≥20 days) (OR = 2.6, 95% CI = 1.69–3.88, p < .001), prolonged length of hospital stay (≥18 days) (OR = 2.1, 95% CI = 1.27–3.45, p = .004), and multiple hospital admissions (≥2) (OR = 1.8, 95% CI = 1.13–2.82, p = .01) compared with nondepressed diabetic patients.

Conclusions:

These findings further document the association between depression and health resource utilization and lost productivity in people with diabetes. Screening and treating depression are important for everyday clinical care and public health initiatives to improve health outcomes for people with diabetes.

BDI = Beck Depression Inventory;

BMI = body mass index;

LOS = length of hospital stay.